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Heterosexual HIV Rates Higher Among Poor, Jobless

By Michael Smith, North American Correspondent, MedPage Today
Published: August 11, 2011
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston

Poverty, joblessness, and limited education may play an important role in HIV risk among heterosexuals, the CDC reported.

In its first survey among heterosexuals, the agency found that HIV prevalence was higher among those with low socioeconomic status.

The link was independent of traditional HIV risk factors among heterosexuals, such as use of crack cocaine and exchanging sex for money or drugs, the CDC reported in the Aug. 12 issue of Morbidity and Mortality Weekly Report.

The finding comes from the National HIV Behavioral Surveillance System, which conducts a yearly cross-sectional survey of one of three groups at high risk for HIV: men who have sex with men, injection drug users, and heterosexuals at increased risk.

Heterosexuals were first surveyed between September 2006 and October 2007 and the current report reflects those numbers.

All told, 14,837 people, living in 24 metropolitan statistical areas with a high prevalence of AIDS, took part in the survey.

All participants answered a computer-based questionnaire and had an HIV test. All told, 294 participants, or 2%, tested positive for HIV and prevalence was similar among men and women, at 1.9% and 2.1%, respectively.

The rate is 10 to 20 times higher than the estimated rate among all U.S. heterosexuals who are not injection drug users, the agency noted, possibly because they were recruited from areas with a high prevalence of AIDS.

However, in a multivariate analysis, there was no difference in prevalence along racial or ethnic lines. Rates among Hispanics, whites, and other groups – 1.3%, 0.6%, and 0.9%, respectively – did not differ significantly from the 2.1% rate among blacks.

That again was at odds with the national picture, in which HIV prevalence among blacks is more than eight times that among whites and among Hispanics is three times that among whites, the CDC noted.

But the key finding was that poverty, lack of education, and unemployment were associated with significantly higher rates of HIV. Specifically, the rate was:

• 2.8% among participants with less than a high school education and 1.2% among those with more than a high school education

• 2.6% among those who were unemployed and 1.0% among those with jobs

• 2.3% among those with annual household incomes of $9,999 or less and 1.0% among those whose incomes were $10,000 to $49,999

Taken together, the socioeconomic and racial/ethnic data imply that "poverty-related factors might account for some of the racial/ethnic disparities in HIV prevalence observed nationally," the agency suggested, since blacks and Hispanics are about four times as likely as whites to live in low-income areas like those in the survey.

The CDC study also found that traditional risk factors played a role in HIV rates, but after controlling for other factors, only a previous diagnosis of a sexually transmitted disease was significantly associated with HIV infection. In the survey, prevalence was 4% among those who had had an STD diagnosis and 1.7% for those without such a history.

The agency cautioned that the analysis took place among people living in high-risk areas, so results may not apply to all low-income heterosexuals in the U.S.

Similarly, the choice of the 24 regions with both a high rate of HIV and poverty might have led to overestimation of HIV prevalence, the CDC noted.

The authors also cited a potential for stigma in reporting male-to-male sexual behavior or injection drug use as a possible limitation in assessing incidence of other risk factors for HIV.

The analysis was supported by the CDC. The authors are employees of the agency.

Primary source: Morbidity and Mortality Weekly Report
Source reference:
Centers for Disease Control and Prevention. "Characteristics associated with HIV infection among heterosexuals in urban areas with high AIDS prevalence -- 24 cities, United States, 2006–2007" MMWR 2011; 60: 1045-1049 [ http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6031a1.htm ].

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This report is part of a 12-month Clinical Context series.
http://www.medpagetoday.com/clinical-context/HIVAIDS/

© 2011 Everyday Health, Inc.

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Poor Urban Heterosexuals at High Risk of HIV: CDC

Risk up to 20 times greater in metropolitan areas with high rates of AIDS

Posted: August 11, 2011

THURSDAY, Aug. 11 (HealthDay News) -- The HIV infection rate among low-income heterosexuals in 24 American cities with a high prevalence of AIDS is 10 to 20 times greater than in the general U.S. population, a new government report indicates.

Two percent of poor heterosexuals in those cities have HIV, according to the U.S. Centers for Disease Control and Prevention researchers' analysis of National HIV Behavioral Surveillance System data.

HIV is the virus that causes AIDS.

The link between high HIV rates and low socioeconomic status couldn't be attributed to factors typically associated with HIV infection risk in heterosexuals, such as crack cocaine use, being diagnosed with a sexually transmitted disease, or having an exchange sex partner, the investigators noted.

While major racial disparities are a feature of the HIV/AIDS epidemic in the United States, the researchers found no racial/ethnic-related differences in HIV infection rates among low-income heterosexuals in cities.

Based on their findings, the CDC authors recommended that HIV prevention programs aimed at heterosexuals should focus on those in low-income areas.

The study is published in the Aug. 12 issue of the Morbidity and Mortality Weekly Report, published by the CDC. Preliminary results from the study were presented in July 2010 at an international AIDS conference in Vienna, Austria.

More information

The U.S. National Institute of Allergy and Infectious Diseases has more about HIV/AIDS.

Copyright © 2011 HealthDay

http://health.usnews.com/health-news/managing-your-healthcare/economics/articles/2011/08/11/poor-urban-heterosexuals-at-high-risk-of-hiv-cdc


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